1. Stress

2. Three Views of Stress 1. Focus on the environment: stress as a stimulus (stressors) 2. Reaction to stress: stress as a response (distress) 3. Relationship between person and the environment: stress as an interaction (coping)

3. Stressors Some examples?

4. Stressors War Overcrowding Deadlines Dense traffic Marital conflict Work stress

5. Acute vs. Chronic Stress Acute stress Sudden, typically short-lived, threatening event (e.g., robbery, giving a speech) Chronic stress Ongoing environmental demand (e.g., marital conflict, work stress, personality)

6. Acute Stress

7. Acute Stress – Rozanski 1988 Subjects – 39 individuals with coronary artery disease Stress tasks (0-5 minutes each): Mental arithmetic Stroop-colour word conflict task Stress speech (talk about personal fault) Graded exercise on bicycle (until chest pain or exhaustion)

8. Acute Stress – Rozanski 1988 Outcome – stress response Myocardial ischemia determined by radionuclide ventriculography (measures wall motion abnormalities in the heart)

9. Acute Stress – Rozanski 1988 Results Cardiac wall motion abnormalities were significantly greater with stress speech than other mental stress tasks (p <.05) and was of the same order of magnitude as that with graded exercise. Wall motion abnormalities occurred with lower heart rate during stress than during exercise (64 vs. 94 beats/min, p <.001)

10. Chronic Stress – Frankenhauser, 1989 Subjects – 30 managerial and 30 clerical workers Equal number of men and women Outcome: blood pressure, heart rate, and catecholamines measured throughout workday and non-workday.

12. Chronic Stress – Frankenhauser, 1989 No gender differences in the effect of work on BP and HR. In both men and women, BP and HR were higher on a workday than a non- workday.

13. Chronic Stress – Frankenhauser, 1989 Time of Day Catecholamine Response

14. Three Views of Stress 1. Focus on the environment: stress as a stimulus (stressors) 2. Reaction to stress: stress as a response (distress) 3. Relationship between person and the environment: stress as an interaction (coping)

15. Fight or Flight Response Increase in Epinephrine & norepinephrine Cortisol Heart rate & blood pressure Levels & mobilization of free fatty acids, cholesterol & triglycerides Platelet adhesiveness & aggregation Decrease in Blood flow to the kidneys, skin and gut

16. Selye’s General Adaption Syndrome (1956, 1976, 1985) Perceived Stressor Alarm Reaction Fight or flight Resistance Arousal high as body tries defend and adapt. Exhaustion Limited physical resources; resistance to disease collapses; death If stress continues ….

17. Cognitive Model of Stress Lazarus & Folkman Potential stressor (external event) Primary appraisal – is this event positive, neutral or negative; and if negative, how bad? Secondary appraisal – do I have resources or skills to handle event? If No, then distress.

18. Cognitive Model of Stress Lazarus & Folkman Primary appraisal – Is there a potential threat? Outcome – Is it irrelevant, good, or stressful? If stressful, evaluate further: Harm-loss – amount of damage already caused. Threat – expectation for future harm. Challenge – opportunity to achieve growth, etc

19. Cognitive Model of Stress Lazarus & Folkman Secondary appraisal – Do I have the resources to deal effectively with this challenge or stressor?

20. Cognitive Model of Stress Lazarus & Folkman High ThreatLow ResourcesHigh Stress High ThreatHigh Resources Moderate Stress Low ThreatLow ResourcesSome stress Low ThreatHigh Resources Low or no stress

21. Personal Factors Affecting Stress Appraisal Intellectual Motivational Personality Beliefs

22. Situational Factors Affecting Stress Appraisals Strong demands Imminent Life transition Timing Ambiguity – role or harm ambiguity Desirability Controllability Behavioural control – perform an action Cognitive control – using a mental strategy

23. Learned Helplessness – Seligman, Peterson, et al. Dogs exposed to unavoidable shocks Following exposure, when placed in a situation where they can now jump to avoid the shock, they fail to make the escape response. Learned helplessness occurs when one perceives that one’s actions (e.g., working hard) does not lead to the expected outcome (e.g., high grade).

24. Job Strain – Karasek et l., 1981 Demands HighLow Control High LowSTRAIN

25. Job Stress – other aspects Physical environment Poor interpersonal relationships Perceived inadequate recognition or advancement Unemployment (even anticipated) Role conflict High responsibility for others

26. Biopsychosocial Aspect of Stress How stress affects health Via behaviour Via physiology

27. Behavioural Aspects Increased alcohol Smoking Increased caffeine Poor diet Inattention leading to carelessness

28. Physiological Aspects Cardiovascular reactivity – increased blood pressure, platelets, lipids (cholesterol) Endocrine reactivity – increased catecholamines and corticosteroids Immune reactivity – increased hormones impairs immune function

29. Psychophysiological Disorders Digestive system – e.g., ulcers, irritable bowel syndrome Respiratory system – e.g., asthma Cardiovascular system – e.g., hypertension, lipid disorders, heart attack, angina

30. Stress-Illness Relationship Preexisting physiological or psychological vulnerability Exposure to stress Physiological & psychological wear and tear Behavioural changes & Coping efforts Illness precursors, symptoms Illness behaviour

31. What is coping? Process of managing the discrepancy between the demands of the situation and the available resources. Ongoing process of appraisal and reappraisal (not static) Can alter the stress problem OR regulate the emotional response.

32. Emotion-Focused Coping Aimed at controlling the emotional response to the stressor. Behavioural (use of drugs, alcohol, social support, distraction) and cognitive (change the meaning of the stress). Often used when the person feels he/she can’t change the stressor (e.g., bereavement); or Doesn’t have resources to deal with the demand.

33. Problem-Focused Coping Aimed at reducing the demands of the situation or expanding the resources for dealing with it. Often used when the person believes that the demand is changeable.

34. Coping responses – respond yes or no. 1. Tried to see the positive side of it. 2. Tried to step back from the situation and be more objective. 3. Prayed for guidance or strength. 4. Sometimes took it out on others when I felt angry and depressed. 5. Got busy with other things to keep my mind off the problem. 6. Read relevant material for solutions and considered several alternatives. 7. Took some action to improve the situation.

35. Problem-Focused Coping Planful Problem-Solving – analyzing the situation to arrive at solutions and then taking direct action to correct the problem. Confrontive Coping – taking assertive action, often involving anger or risk taking to change the situation.

36. Emotion-Focused Coping Seeking social support – can be either problem or emotion-focused coping. Distancing – cognitive effort to detach Escape-avoidance – wishful thinking or taking action to escape or avoid it. Self-control – attempting to modulate one’s feelings in response to the stressor. Accepting responsibility – acknowledging one’s role in the situation while trying to put things right. Positive reappraisal – create positive meaning.

37. Cognitive Re-structuring Process by which stress-provoking thoughts are replaced with more constructive one.

38. Personality or Coping Style Negative affectivity Pessimism – optimism Hardiness

39. Life Orientation Test (Scheier & Carver) 1 In uncertain times, I usually expect the best. 2 If something can go wrong for me it will. 3 I always look on the bright side. 4 I’m always optimistic about my future. 5 I hardly ever expect things to go my way. 6 Things never work out the way I want them to. 7 I’m a believer in the idea that “every cloud has a silver lining.” 8 I rarely count on good things happening to me. 9 Overall, I expect more good things to happen to me than bad.

40. Personality or Coping Style Negative affectivity Pessimism – optimism Hardiness

41. Social Support Emotional support – expression of empathy, understanding, caring, etc. Esteem support – positive regard, encouragement, validating self-worth Tangible or instrumental – lending a helpful hand. Information support – providing information, new insights, advice. Network support – feeling of belonging

42. Alxheimer’s Disease (AD) – Effect on Caregivers Subsample of the Cardiovascular (CVD) Health Study, a prospective study of risk factors for CVD in the elderly. Excluded: disabled confined to wheel chair, unable to attend field centres, or undergoing cancer treatment. Caregivers defined as those whose spouse had difficulty with one activity of daily living due to physical or mental health problem. 392 caregivers and 427 non-caregivers recruited.

43. AD – Effect on Caregivers Caregivers were asked to rate the degree of mental and physical strain associated with caregiving (3-point response format). Sample subdivided into four groups: non- caregivers; spouse disabled but not helping him/her; caregiver but no reports of strain; and caregiver with reports of strain. Followed for 4.5 years (range 3.4 – 5.5 years). Main outcome – mortality (100% follow-up achieved).

44. AD – Effect on Caregivers Results 81% of caregivers were providing care. 56% reported caregiver strain. Mortality – 9.4% in non-caregivers; 17.3% in ‘caregivers’ not providing care; 13.8% in non-strained caregivers; and 17.3% in strained caregivers.

45. Stress Management

46. Stress Management – teaches coping techniques Reduce harmful environmental conditions Teaches techniques by which person can develop stress tolerance. Helps client maintain a positive self-image. Help maintain emotional equilibrium. Help client maintain or develop satisfying relations with others.

47. Cognitive Therapy – Albert Ellis, Aaron Beck Assumes that stress arises or is augmented by faulty or irrational ways of thinking. Catastrophizing – “It is awful if I get turned down when I ask for a date”. Overgeneralizing – “I didn’t get a good grade on this test. I can’t get anything right”. Selective abstraction – Only seeing specific details of the situation (e.g., Seeing the negatives but missing the positive details).

48. Cognitive Therapy Often these irrational beliefs or faulty thinking errors stem from past “programming”. E.g., Not receiving adequate love and nurturance as a child may lead to feelings that loved ones in the present don’t “quite love you enough”. Hypothesis testing – client is encouraged to test out these irrational beliefs by collecting evidence for or against the belief.

49. Relaxation Therapy Aims to either reduce hyperarousal or curb emotional-physiological reactivity. Progressive muscular relaxation Mental imagery Meditation Autogenic training